Validity of subjective assessment of changes in respiratory health status: a 30 year epidemiological study of workers in Paris

Abstract

The validity of scales used for subjective assessment of health, particularly transitional indices, is under discussion. The aim of the present study was to assess the concurrent and predictive validity of a simple estimate of long-term subjective assessment of respiratory health changes.A longitudinal study of 915 workers was conducted over 30 yrs, with both retrospective self-assessment of respiratory health changes and objective measurements of spirometric values 12 yrs apart. An assessment of the reason for death during the subsequent 20 yrs was performed.Subjective assessment of respiratory deterioration over 12 yrs was significantly related to both cross-sectional lung function values and longitudinal lung function changes (forced expiratory volume in one second (FEV1) decline), an association which remained after adjustment for FEV1 level. It was also related to the same risk factors as decline in FEV1 (smoking, occupational exposure). Self-evaluation of respiratory deterioration was significantly predictive of death from all causes, with the highest (but nonsignificant) rate ratio for respiratory causes. Asthmatics exhibited greater long-term variability (objective and subjective) than nonasthmatics. Independent of dyspnoea, self-assessment of respiratory health deterioration was significantly related to FEV1.Subjective assessment of long-term changes in respiratory health provides valid information. Eur Respir J 1997; 10: 2508-2514 The acceptance of self-perception of health status is relatively recent [1][2][3][4]. The validity of perceived health measures (which are the basis of items included in health-related quality of life scales) is a matter of discussion as objective measures of the same or highly related phenomenon are rarely available or relevant [5][6][7]. Responsiveness, i.e. the ability to detect changes between repeated measurements, is an important quality [2,6]. Transitional indices [6, 8-10] (i.e. those designed to directly assess perceived changes over time) are rarely used. Such indices are retrospectively assessed at the end of the period under study. The duration for which change is assessed is often short (less than 1 yr), and the interpretation of such transitional indices can be hampered by potential recall bias. Valid long-term assessment of respiratory health changes may be of interest for both epidemiological research and clinical practice. No study has assessed long-term perceived respiratory changes.The general aim of the present study was to assess the concurrent and predictive validity of a simple estimate of long-term subjective assessment of respiratory health changes using objective criteria recorded in the same longitudinal survey conducted in a working population. The specific aims were to assess whether retrospective subjective assessment of changes at 12 yrs was related to known risk factors of forced expiratory volume in one second (FEV1) decline, 12 yr FEV1 decline itself, a history of asthma, and 20 yr mortality data. MethodsThe subjects in the study we...

Review on the validity of self-report to assess work-related diseases

“…immediately after answering questionnaireFinland: farmers, 41 with and 122 without dermatitis12, Moderate20Svensson et al (2002)Symptom Based Questionnaire Self-diagnosis single question: “Do you have hand eczema at the moment?”NoDermatologist examined their hands immediately after that without knowing the participants’ answersSweden: 95 patients referred for hand eczema; 113 workers (40 dentists, 73 office workers)18, High21Vermeulen et al (2000)Symptom Based QuestionnaireNoMedical evaluation by 1 of 2 dermatologists in same week. Case definitions of medically confirmed hand dermatitis (major/minor) clearly statedNetherlands: 202 employees in the rubber manufacturing industry15, Moderate Respiratory disorders 22Bolen et al (2007)Measures of self-reported work aggravated asthma: Yes Serial peak expiratory flow (PEF) testingUSA: 95 out of 382 (25%) workers enrolled in a health plan (Health Maintenance Organisation); from 382 invited, 178 had spirometry (47%), and 138 (36%) did > 2 w PEF (peak expiratory flow) testing10, LowDaily log on symptoms and medication usePost-test telephone survey on symptoms and medication use23Demers et al (1990)Researcher Designed questionnaire on respiratory symptomsNoClinical examination with X-ray and pulmonary function testingUSA: 923 construction workers (union members; boilermakers, pipefitters; 71% working, 70% response)15, Moderate24Johnson et al (2009)Farm Health Interview Survey on lung symptoms through Telephone surveyNoPhysical examination and spirometry by an occupational physician or an advanced practice registered nurseUSA: 160 farmers, working; 134 farmers completed spirometry12, Low25Kauffmann et al (1997)Single question: “Do you think that your bronchial or respiratory status has changed (over 12 yr)? Feels worse/better?”NoPulmonary fu...…”

“…Comparable results on the influence of case definition were reported by Perreault et al (2008) and Vermeulen et al (2000). Looking at the influence of heterogeneity in the reference standard, it showed that comparison of self-report with clinical examination seemed to result in mainly moderate agreement, whereas comparison of self-report with test results was low for exposure-related symptoms and tests (Lundström et al 2008; Dasgupta et al 2007) and moderate for hearing loss (Gomez et al 2001) and self-rated pulmonary health change (Kauffmann et al 1997). …”

Airflow Limitation is Underrecognized in Well‐Functioning Older People

“…This reduction in activity is likely to exacerbate the progression of age‐related conditions such as sarcopenia and osteopenia. Patients with respiratory symptoms have a higher prevalence of airway disease in most cohort studies, 4,20 and self‐reported respiratory symptoms were predictive of decline in lung function and subsequent mortality in a 30‐year cohort study in Paris 23 . Unfortunately, when dyspnea is reported, its predictive value for airflow limitation is poor 20 .…”

“…Patients with respiratory symptoms have a higher prevalence of airway disease in most cohort studies, 4,20 and self-reported respiratory symptoms were predictive of decline in lung function and subsequent mortality in a 30-year cohort study in Paris. 23 Unfortunately, when dyspnea is reported, its predictive value for airflow limitation is poor. 20 This discrepancy results in the physician's inability to rely on the presence or absence of symptoms to diagnose or exclude airways disease.…”

Perceived 10-year change in respiratory health: Reliability and predictive ability

“…However, in chronic conditions which wax and wane over time, like asthma, longer period of time (years) may allow to retrospectively address the overall change in disease trajectory. Despite the clinical and epidemiological relevance of such long-term selfreported transition question in asthma, a single previous work showed concurrent and predictive ability of a perceived 10-year change in respiratory health [16]. But results were limited to a specific male working population with little proportion of subjects with asthma.…”